CATEGORIES, COMMON INFECTIVE
AND INFLAMMATORY DISORDERS
DR. NAILA ALI
Assistant Professor
OPHTHALMOLOGY

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Congenital Anomalies
Inflammations
Disorders of position.
Trauma
Tumours

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Stye
Chalazion
Lid cellulitis
Preseptal orbital cellulitis
Blephritis
Anterior
Posterior

Treatment Options for Trichiasis
1. Epilation - but recurrences within few weeks
2. Electrolysis - but frequently repeated treatments required
3. Cryotherapy - for many lashes
4. Laser ablation - for few scattered lashes
5. Surgery - for localized crop resistant to other methods

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Small abscess, staph infection of the eyelash, gland of Zeis or Moll
Tender, inflammed swelling in lid margin, single or multiple, may involve entire lid margin– preseptal cellulitis
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Treat with hot compresses, removal of eyelash or systemic antibiotics in severe cases
Drain if puss points

Chalazion (Tarsal cyst or mebomian cyst)
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Chronic inflammatory granuloma of mebomian gland—blockage and accumulation of secretions
One or more glands involved, mainly children and young adults involved
Swelling, heaviness, irritation blurring if large- induced astigmatism

Chalazion (Tarsal cyst or mebomian cyst)
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Small, cystic, hard swelling a little away from the lid margin, fixed to tarsus, non-tender
No signs of inflammation,no lymphadanopathy
Small may resolve, may remain the same,
 may burst on skin- fistula
 may infect- internal hordeolum.
treatment
 Surgery
 steroid injections
 Leave alone the small ones.

Painless, roundish, firm lesion within tarsal plate
May rupture through conjunctiva and cause granuloma

Multiple, round spaces previously containing fat with surrounding granulomatous inflammation
Epithelioid Multinucleated cells giant cells

Injection of local anaesthetic Insertion of clamp
Incision & curettage

Internal hordeolum
External hordeolum (stye)
( acute chalazion )
• Staph. abscess of
• Meibomian glands
• Tender swelling
• Staph. abscess of lash follicle and gland of Zeis or Moll
• Tender swelling at lid margin
• May discharge through skin or conjunctiva
• May discharge through skin

 Etiology
 Multiple styes
 Insect bites
 Trauma
Clinical features whole of the lid is involved tender induration may lead to abscess formation/ skin necrosis
Treatment
Systemic antibiotics
Drainage

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CHRONIC MARGINAL BLEPHARITIS
1. Anterior
• Staphylococcal
• Seborrhoeic
2. Posterior
• Meibomianitis
• Meibomian seborrhoea

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Usually chronic infection of the lid margin
Common external eye disease
Causes—not clear but staph infection and sebhorrea play a part
Associated with tear film instability
Anterior and posterior variety
Anterior blephritis—staph or ulcerative and
Sebhorroeic or squamous

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Chronic infection of the bases of the lashes resulting in tiny intrafollicular abscesses
Secondary dermal and epidermal ulceration and tissue distruction
More common in children but may affect any age group
Females more affected than males
Unhygienic conditions and dietary factors involved

Staph Anterior Blephritis—Cont.
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Symptoms:
Sourness of lid margin
Lacrimation, itching and photophobia
Signs:
Yellow crusts at the roots of the lids
On removing the crusts, small ulcers may appear
Fall of the lashes—either not replaced or abnormal replacement

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Complications
If not treat may lead to
Poliosis, madarosis, trichiasis, tylosis
Treatment:
General:
Improvement in general health
Balanced diet
Correction of refractive errors
Local:
Broad spectrum antibiotic ointment, steroid ointment
Artificial tears.
Treat the sequlae.

Staphylococcal blepharitis
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Chronic irritation worse in mornings
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Scales around base of lashes
(collarettes)
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Hyperaemia and telangiectasia of anterior lid margin
Scarring and hypertrophy if longstanding

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Disorder of the glands of Zeis and Moll
Sebhorreoa may involve scalp, eyebrows, nasolabial folds, retroauricular area and sternum.
 Oily type and dry type (true seborrheoa)

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Symptoms: less severe, discomfort in the eyes, lacrimation, tear film instability (stinging)
Signs:
Shiny, waxy appearance of the anterior lid margin, dandruff like desquamation lid epidermis (yellow, greasy scales)
Treatment:
Lid hygiene— artificial tears
Scalp treatment with antidandruff lotion

Seborrhoeic blepharitis
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Shiny anterior lid margin
Hyperaemia of lid margin
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Greasy scales
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Lashes stuck together

 May present as:
*Dysfunction of the mebomian glands.
*Isolated mebomian seborrhoea and primary mebomenitis.
*Combination of ant. Seb. Blephritis and meibominitis

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Diffuse inflammation around glands
Associated with acne rosacea (2/3 rd ) or Seb. Dermatitis (1/3 rd )
Signs:
*Pouting of gland orifices with dome of secretions—may become solid.
(tooth-past like)
*Obliteration of ducts—dilatation (thick, round, vascularised, notched
Posterior border)
*Secondary changes include papillary conjunctivitis, punctate epitheliopathy, and tear film instability (stinging)

Meibomianitis

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Dilated mebomian glands—easily expressed
Tear film is oily and foamy
In severe cases—mebomian foam at medial canthus.

Meibomian seborrhoea
Oil globules over meibomian gland orifices
Oily and foamy tear film

Treatment:
A: Systemic antibiotics
Tetracycline, Doxocycline,
Erythromycin
B: Others:
Lid hygiene, topical steroids, artificial tears.
C: Local measures:
Warm compresses, mechanical expressions of secretions

Complications trichiasis,madarosis, poliosis Recurrent styes
Marginal keratitis Tear film instability

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Lid margin
Lid tissue
Loss of lid tissue

Eyelid haematoma
Usually innocuous but exclude associated trauma to globe or orbit
Orbital roof fracture if associated with subconjunctival haemorrhage without visible posterior limit
Basal skull fracture - bilateral ring haematomas (‘panda eyes’)